Combination Therapies for Erectile Dysfunction-A Synergy of Modalities Holds the Key
Abstract
The systematic review and meta-analysis by Mykoniatis et al1 compared the literature on combination therapy vs monotherapy for the treatment of erectile dysfunction (ED). The authors found that combination therapy with phosphodiesterase type 5 (PDE5) inhibitors in conjunction with other accepted treatment modalities, including tadalafil, low-intensity extracorporeal shockwave therapy (Li-ESWT), vacuum erectile device, or antioxidants, was associated with statistically significant improvements in symptoms as measured by the International Index of Erectile function (IIEF) score, with no increase in adverse effects. However, certain limitations exist in this review and should be considered when interpreting the its conclusions. Since the first PDE5 inhibitor, sildenafil citrate, was approved by the US Food and Drug Administration in 1998,2 this class of medications has revolutionized the management of ED. To date, 4 individual PDE5 inhibitors have been approved by the US Food and Drug Administration; they have unique properties but a similar overall efficacy. These PDE5 inhibitors, in addition to intracavernosal injection therapies, are associated with the most successful non–device-based current strategies for mild to moderate cases of ED. Mykoniatis et al1 found a modest but statistically significant improvement in objective IIEFs scores (1.76 points; 95% CI, 1.27-2.24) with the use of combination therapy compared with standard PDE5 inhibitor monotherapy. It must be noted…
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